Download PDF
CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(03): E443-E449
DOI: 10.1055/a-1336-2766
Original article

Intraluminal gas escape from biopsy valves and endoscopic devices during endoscopy: caution advised during the COVID-19 era

Shinya Urakawa
1   Department of Surgery, Weill Cornell Medicine/New York Presbyterian Hospital, New York, New York, United States
2   Department of Next Generation Endoscopic Intervention (Project ENGINE), Osaka University Graduate School of Medicine, Osaka, Japan
,
Teijiro Hirashita
1   Department of Surgery, Weill Cornell Medicine/New York Presbyterian Hospital, New York, New York, United States
,
Kota Momose
3   Department of Surgery, Kindai University Faculty of Medicine, Osaka, Japan.
,
Makoto Nishimura
4   Gastroenterology, Hepatology and Nutrition Service, Memorial Sloan Kettering Cancer Center, New York, New York, United States
,
Kiyokazu Nakajima
2   Department of Next Generation Endoscopic Intervention (Project ENGINE), Osaka University Graduate School of Medicine, Osaka, Japan
,
Jeffrey W. Milsom
1   Department of Surgery, Weill Cornell Medicine/New York Presbyterian Hospital, New York, New York, United States
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Referred to by:

Gas leakage from the biopsy valve: Does it matter in the era of COVID-19?Endosc Int Open 2021; 09(03): E450-E452
DOI: 10.1055/a-1339-1259

Abstract

Background and study aims The risk of aerosolization of body fluids during endoscopic procedures should be evaluated during the COVID-19 era, as this may contribute to serious disease transmission. Here, we aimed to investigate if use of endoscopic tools during flexible endoscopy may permit gas leakage from the scope or tools.

Material and methods Using a fresh 35-cm porcine rectal segment, a colonoscope tip, and manometer were placed intraluminally at opposite ends of the segment. The colonoscope handle, including the biopsy valve, was submerged in a water bath. Sequentially, various endoscopic devices (forceps, clips, snares, endoscopic submucosal dissection (ESD) knives) were inserted into the biopsy valve, simultaneously submerging the device handle in a water bath. The bowel was slowly inflated up to 74.7 mmHg (40 inH2O) and presence of gas leakage, leak pressure, and gas leakage volume were measured.

Results Gas leakage was observed from the biopsy valve upon insertion and removal of all endoscopic device tips with jaws, even at 0 mmHg (60/60 trials). The insertion angle of the tool affected extent of gas leakage. In addition, gas leakage was observed from the device handles (8 of 10 devices) with continuous gas leakage at low pressures, especially two snares at 0 mmHg, and an injectable ESD knife at 0.7 ± 0.8 mmHg).

Conclusions Gas leakage from the biopsy valve and device handles commonly occur during endoscopic procedures. We recommend protective measures be considered during use of any tools during endoscopy.

Supplementary material



Publication History

Received: 06 August 2020

Accepted: 23 November 2020

Article published online:
19 February 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Judson SD, Munster VJ. Nosocomial transmission of emerging viruses via aerosol-generating medical procedures. Viruses 2019; 11: 940
    CrossrefPubMedGoogle Scholar
  • 2 van-Deremalen N, Bushmaker T, Morris DH. et al. Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1. N Engl J Med 2020; 382: 1564-1567
    CrossrefPubMedGoogle Scholar
  • 3 Soetikno R, Teoh AY, Kaltenbach T. et al. Considerations in performing endoscopy during the COVID-19 pandemic. Gastrointest Endosc 2020; 92: 176-183
    CrossrefPubMedGoogle Scholar
  • 4 Repici A, Maselli R, Colombo M. et al. Coronavirus (COVID-19) outbreak: what the department of endoscopy should know. Gastrointest Endosc 2020; 92: 192-197
    CrossrefPubMedGoogle Scholar
  • 5 An P, Huang X, Wan X. et al. ERCP during the pandemic of COVID-19 in Wuhan, China. Gastrointest Endosc 2020; 92: 448-454
    CrossrefPubMedGoogle Scholar
  • 6 Wu D, Wu T, Liu Q. et al. The SARS-CoV-2 outbreak: What we know. Int J Infect Dis 2020; 94: 44-48
    CrossrefPubMedGoogle Scholar
  • 7 Xiao F, Tang M, Zheng X. et al. Evidence for gastrointestinal infection of SARS-CoV-2. Gastroenterology 2020; 158: 1831-1833
    CrossrefPubMedGoogle Scholar
  • 8 Gu J, Han B, Wang J. COVID-19: Gastrointestinal manifestations and potential fecal-oral transmission. Gastroenterology 2020; 158: 1518-1519
    CrossrefPubMedGoogle Scholar
  • 9 Marchese M, Capannolo A, Lombardi L. et al. Use of a modified ventilation mask to avoid aerosolizing spread of droplets for short endoscopic procedures during Coronavirus Covid-19 outbreak. Gastrointest Endosc 2020; 92: 439-440
    CrossrefPubMedGoogle Scholar
  • 10 Neven L, Sanja SS, Lucija VJ. et al. Plexiglass barrier box to improve ERCP safety during the COVID-19 pandemic. Gastrointest Endosc 2020; 92: 428-429
    CrossrefPubMedGoogle Scholar
  • 11 Mele A, Spada E, Sagliocca L. et al. Risk of parenterally transmitted hepatitis following exposure to surgery or other invasive procedures results from the hepatitis surveillance system in Italy. J Hepatol 2001; 35: 284-289
    CrossrefPubMedGoogle Scholar
  • 12 Kovaleva J, Peters FT, van der Mei HC. et al. Transmission of infection by flexible gastrointestinal endoscopy and bronchoscopy. Clin Microbiol Rev 2013; 26: 231-254
    CrossrefPubMedGoogle Scholar
  • 13 Zietsman M, Phan LT, Jones RM. Potential for occupational exposures to pathogens during bronchoscopy procedures. J Occup Environ Hyg 2019; 16: 707-716
    CrossrefPubMedGoogle Scholar
  • 14 Lentz RJ, Colt H. Summarizing societal guidelines regarding bronchoscopy during the COVID-19 pandemic. Respirology 2020; 25: 574-577
    CrossrefPubMedGoogle Scholar
  • 15 Lavoie J, Marchand G, Cloutier Y. et al. Evaluation of bioaerosol exposures during hospital bronchoscopy examinations. Environment Sci Proc Impacts 2015; 17: 288-299
    CrossrefPubMedGoogle Scholar
  • 16 Johnston ER, Habib-Bein N, Dueker JM. et al. Risk of bacterial exposure to the endoscopistʼs face during endoscopy. Gastrointest Endosc 2019; 89: 818-824
    CrossrefPubMedGoogle Scholar
  • 17 Zhang Y, Zhang X, Liu L. et al. Suggestions of infection prevention and control in digestive endoscopy during current 2019-nCoV pneumonia outbreak in Wuhan, Hubei province, China. Endoscopy 2020; 52: 312-314
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 Laine L, Jensen DM. Management of patients with ulcer bleeding. Am J Gastroenterol 2012; 107: 345-360
    CrossrefPubMedGoogle Scholar
  • 19 Cavaliere K, Levine C, Wander P. et al. Management of upper GI bleeding in patients with COVID-19 pneumonia. Gastrointest Endosc 2020; 92: 454-455
    CrossrefPubMedGoogle Scholar
  • 20 Ehlken H, Schachschal G, Mann O. et al. Waiting times for endotherapy of early malignancy: No problem?. Gastrointest Endosc 2020; 92: 424-426
    CrossrefPubMedGoogle Scholar
  • 21 Alp E, Bijl D, Bleichrodt RP. et al. Surgical smoke and infection control. J Hosp Infect 2006; 62: 1-5
    CrossrefPubMedGoogle Scholar
  • 22 Castro Filho EC, Castro R, Fernandes FF. et al. Gastrointestinal endoscopy during COVID-19 pandemic: an updated review of guidelines and statements from international and national societies. Gastrointest Endosc 2020; 92: 440-445
    CrossrefPubMedGoogle Scholar
  • 23 World Health Organization. Rational use of personal protective equipment (PPE) for coronavirus disease (COVID-19): Interim Guidance, 19. 2020 Available from: https://apps.who.int/iris/handle/10665/331215
    PubMedGoogle Scholar
  • 24 Chen JH, Yu Y, Yang Z. et al. Intraluminal pressure patterns in the human colon assessed by high-resolution manometry. Sci Rep 2017; 7: 41436
    CrossrefPubMedGoogle Scholar
  • 25 Hirota M, Miyazaki Y, Takahashi T. et al. Dynamic article: steady pressure CO2 colonoscopy; its feasibility and underlying mechanism. Dis Colon Rectum 2014; 57: 1120-1128
    CrossrefPubMedGoogle Scholar
  • 26 Kato M, Nakajima K, Yamada T. et al. Esophageal submucosal dissection under steady pressure automatically controlled endoscopy (SPACE): a clinical feasibility study. Endoscopy 2014; 46: 680-684
    Article in Thieme ConnectPubMedGoogle Scholar
  • 27 Mukai S, Itoi T, Baron TH. et al. Indications and techniques of biliary drainage for acute cholangitis in updated Tokyo Guidelines 2018. J Hepatobiliary Pancreat Sci 2017; 24: 537-549
    CrossrefPubMedGoogle Scholar
  • 28 Mintz Y, Arezzo A, Boni L. et al. A low cost, safe and effective method for smoke evacuation in laparoscopic surgery for suspected coronavirus patients. Ann Surg 2020; 272: 7-8
    CrossrefPubMedGoogle Scholar